Behavioral Mechanisms Of A Sensor-Controlled Digital Game That Motivates Self-Management Behaviors By Older Adults With Heart Failure

Abstract

Introduction Digital games have been found beneficial in promoting health outcomes of people with chronic diseases. However, application of digital games for the self-management of heart failure (HF) in older adults, which could result in reducing hospitalizations related to HF symptom exacerbation and better health outcomes, is yet to be examined. With the emergence and increase use of behavior tracking devices and sensors in healthcare, a sensor-controlled digital game (SCDG) provides an interactive platform that confers instant feedback to participants based on their real-time behaviors, in the form of game rewards/incentives and real-time game progress. SCDG allows for an opportunity to set goals, monitor and analyze participants’ behaviors and to gain an insight of their interaction with the game. Qualitative data were collected from the SCDG intervention participants from a feasibility randomized controlled trial study, which investigated weight-monitoring and physical activity behavior adherence in older adults with HF. Objective The qualitative study aimed to gain in-depth understanding the behavioral mechanisms of SCDG that motivated behavior changes related to daily weight monitoring and physical activity from the HF participants’ perspectives. Michie's Behavior Change Taxonomy and Fogg's Behavior Model guided the qualitative data analysis. Methods We conducted semi-structured phone interviews with 12 English speaking older adults with HF, aged 55 years and older, from Texas and Oklahoma recruited between November 2019 to August 2020. Interviews were done at the 12th week of using the SCDG and pertained to their overall experience, their input on the features and different components of the SCDG and their consequential behaviors. Results Using a directed content analysis approach, six themes were identified, including rewards from playing the game, repetition and substitution of behaviors, feedback and monitoring of progress and behaviors, goal/planning, core motivator of health aspirations related to HF, behavior facilitators and barriers encountered during the intervention. The final themes were obtained after several rounds of reliability checks for rigor in our analysis; the inter-rater reliability went from 71-76% initially to 100% after consensus discussions. Conclusions The findings of this study reveal not only the behavioral mechanisms of a SCDG that motivate self-management behavioral changes but also meaningful quality of life gains experienced by older adults with HF. Moreover, the findings suggest potential avenues to contribute to the advancement of SCDG interventions in order to support and promote self-management behaviors in older adults with HF. Trial Registration Clinicaltrials.gov NCT03947983 Digital games have been found beneficial in promoting health outcomes of people with chronic diseases. However, application of digital games for the self-management of heart failure (HF) in older adults, which could result in reducing hospitalizations related to HF symptom exacerbation and better health outcomes, is yet to be examined. With the emergence and increase use of behavior tracking devices and sensors in healthcare, a sensor-controlled digital game (SCDG) provides an interactive platform that confers instant feedback to participants based on their real-time behaviors, in the form of game rewards/incentives and real-time game progress. SCDG allows for an opportunity to set goals, monitor and analyze participants’ behaviors and to gain an insight of their interaction with the game. Qualitative data were collected from the SCDG intervention participants from a feasibility randomized controlled trial study, which investigated weight-monitoring and physical activity behavior adherence in older adults with HF. The qualitative study aimed to gain in-depth understanding the behavioral mechanisms of SCDG that motivated behavior changes related to daily weight monitoring and physical activity from the HF participants’ perspectives. Michie's Behavior Change Taxonomy and Fogg's Behavior Model guided the qualitative data analysis. We conducted semi-structured phone interviews with 12 English speaking older adults with HF, aged 55 years and older, from Texas and Oklahoma recruited between November 2019 to August 2020. Interviews were done at the 12th week of using the SCDG and pertained to their overall experience, their input on the features and different components of the SCDG and their consequential behaviors. Using a directed content analysis approach, six themes were identified, including rewards from playing the game, repetition and substitution of behaviors, feedback and monitoring of progress and behaviors, goal/planning, core motivator of health aspirations related to HF, behavior facilitators and barriers encountered during the intervention. The final themes were obtained after several rounds of reliability checks for rigor in our analysis; the inter-rater reliability went from 71-76% initially to 100% after consensus discussions. The findings of this study reveal not only the behavioral mechanisms of a SCDG that motivate self-management behavioral changes but also meaningful quality of life gains experienced by older adults with HF. Moreover, the findings suggest potential avenues to contribute to the advancement of SCDG interventions in order to support and promote self-management behaviors in older adults with HF.